• Elias Nasrallah, Hussein Zaitoon, Marina Zeltser, Ran Steinberg, Ran Miron, Hanna Farah, Ranaa Damouni-Shalabi, Imad Kassis, and Halima Dabaja-Younis.
• Pediatric Infectious Diseases Unit, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
• Isr Med Assoc J. 2024 Jun 1; 26 (6): 355360355-360.

BackgroundPseudomonas aeruginosa (PSA) is an infectious pathogen associated with acute appendicitis; however, it is not consistently addressed by empirical antibiotic therapy, despite potential complications.ObjectivesTo investigate the incidence, predictors, and outcomes of PSA-associated acute appendicitis in children.MethodsWe conducted a retrospective analysis involving pediatric patients who underwent acute appendicitis surgery and had positive peritoneal cultures. Clinical, microbiological, and intraoperative data were extracted from medical records.ResultsAmong 2523 children with acute appendicitis, 798 (31.6%) underwent peritoneal cultures, revealing 338 positive cases (42.3%), with PSA detected in 77 cases (22.8%). Children with PSA were three times more likely to exhibit high intraoperative grading ≥ 3 (93.4% vs. 76.8%, 95% confidence interval [95%CI] 1.2-8.3, P = 0.023) and nearly four times more likely to have polymicrobial cultures (88.3% vs. 62.1%, 95%CI 1.8-8.0, P < 0.001) than those without PSA in peritoneal cultures. Duration of symptoms did not predict PSA isolation (P = 0.827). Patients with PSA had longer median hospital stays (8 days, interquartile range [IQR] 7-10) than those with other pathogens (7 days, IQR 5-9) (P = 0.004). Antibiotic treatment duration, intensive care unit admission rates, readmission, and mortality were similar between the two groups (P = 0.893, 0.197, 0.760, and 0.761, respectively).ConclusionsPSA is a common pathogen in children diagnosed with acute appendicitis and positive peritoneal cultures. The likelihood of isolating PSA increases with high-grade intraoperative assessment and in the presence of multiple pathogens in peritoneal cultures, suggests antipseudomonal treatment.

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